Chronic pain is a major symptom of peripheral neuropathies, whether induced by AIDS, cancer chemotherapy, diabetes, or by direct physical trauma to the peripheral nerves. Such neuropathic pain is often highly debilitating and resistant to therapeutic intervention.
Animal models of neuropathic pain have suggested that a prominent feature in the maintenance of the neuropathic state is an abnormal, persistent hyperexcitability of the sensory afferent neurons within the peripheral nerve following injury. In addition, a common clinical finding is that broad-spectrum sodium channel blockers, such as lidocaine, can acutely suppress neuropathic pain. However, the relative contribution of individual sodium channel subtypes in neuropathic pain remains unclear.
Voltage-gated sodium channels are critical for the initiation and propagation of action potentials in neurons. In addition, these channels are involved in the regulation of neuronal excitability. Therefore, voltage-gated sodium channels play an important role in transmitting nociceptive information throughout both the peripheral and central nervous systems. Peripheral nerve injury causes sodium channels to accumulate in the membranes of primary afferents around the site of injury. This results in repetitive firing and an increase in excitability of both injured afferents and their uninjured neighbors. This increase in excitability appears to be critical for the expression of neuropathic pain.
At least ten different isoforms of sodium channels have been identified in the brain, neurons and striated muscles. The major component of sodium channels is the 260 kDa α-subunit, which forms the pore of the channel. The α-subunit is composed of four homologous domains, DI, DII, DIII and DIV, each of which is composed of six transmembrane segments, S1-S6. Most sodium channels associate with auxiliary β-subunits, β1-β4, which have an average molecular weight of 30 kDa. The β-subunits modulate the level of expression and gating of these channels.
Three sodium channel isoforms, Nav1.7, Nav1.8 and Nav1.9, are expressed primarily in the PNS. Nav1.7 is widespread in the peripheral nervous system, such that it is present in all types of dorsal root ganglion neurons, in Schwann cells and in neuroendocrine cells. Nav1.7 is sensitive to nanomolar amounts of tetrodotoxin. Nav1.8 is found only in sensory afferent nerves and neurons of the dorsal root ganglion and trigeminal ganglion. The Nav1.8 channel is highly resistant to tetrodotoxin, with an IC50 of greater than 50 μM. Nav1.9 is also expressed in small fibers of the dorsal root ganglion and trigeminal ganglion and is also resistant to nanomolar concentrations of tetrodotoxin, but is half maximally blocked by ˜40 μM of tetrodotoxin.
Recent interest in the search for therapeutic targets in the treatment of pain has focused on the tetrodotoxin resistant sodium channels found in adult dorsal root ganglion neurons, a significant fraction of which are known to be pain-sensing ‘nociceptors’. One such sodium channel is Nav1.8, which was formerly known as PN3 or peripheral nerve sodium channel type 3. This channel has been found to be upregulated in the dorsal root ganglion in chronic pain states. In addition, the biophysical properties of Nav1.8 make this channel a likely candidate for maintaining the sustained repetitive firing of the peripheral neuron following injury. Moreover, the expression of Nav1.8 being restricted to the periphery in sensory neurons of the dorsal root ganglion, suggests that blockade of this channel might allow relief from neuropathic pain with minimal side effects. However, this possibility can not be tested pharmacologically because currently available sodium channel blockers do not distinguish between sodium channel subtypes.
Antisense oligodeoxynucleotide targeting of Nav1.8 expression in an animal model of neuropathic pain has been employed to test whether a selectively attenuated expression of this channel might allow relief from neuropathic pain. See Porreca et al., “A comparison of the potential role of the tetrodotoxin-insensitive sodium channels, PN3/SNS and NaN/SNS2, in rat models of chronic pain”, Proc. Nat. Acad. Sci., vol. 96, pp. 7640-7644 (1999). Inhibition of Nav1.8 expression using antisense deoxyoligonucleotides has also been found to inhibit chronic pain in other animal pain models. See Yoshimura et al., “The involvement of the tetrodotoxin-resistant sodium channel Nav1.8 (PN3/SNS) in a rat model of visceral pain”, J. Neuroscience, vol. 21, pp. 8690-8696 (2001); and Khasar et al., “A tetrodotoxin-resistant sodium current mediates inflammatory pain in the rat”, Neuroscience Letters, vol. 256, no. 1, pp. 17-20 (1998). Further data indicate that selective knock-down of Nav1.8 protein in the dorsal root ganglion neurons by specific antisense oligodeoxynucleotides to Nav1.8 prevented the hyperalgesia and allodynia caused by spinal nerve ligation injury. See Kim et al., “An experimental model for peripheral neuopathy produced by segmental spinal nerve ligation in the rat”, Pain, vol. 50, pp. 355-363 (1992). The above data suggests a pathophysiological role for Nav1.8 in several peripheral neuropathic and inflammatory states.
However, the use of antisense oligodeoxynucleotides as therapeutics is limited by their instability in vivo, by their limited efficacy and by their tendency to produce ‘off-target’ effects. Since no small molecule has been identified that is capable of specifically blocking Nav1.8, there is a continued need for alternative ways of modulating Nav1.8 in the treatment of pain.
The present invention meets the above need by providing short interfering nucleic acids and siRNAs to specifically knock-down expression of Nav1.8. The use of siRNA is attractive because it has high target specificity, reduced off-target liability and achieves high levels of suppression. siRNA, which stands for short interfering RNA or small interfering RNA, is a form of RNA interference (RNAi). RNAi is a technique used to investigate gene function by degrading a specific mRNA target in a cell, thus knocking-out or knocking-down the level of the encoded protein. The mechanism of action of siRNA is thought to involve a multi-step process. First, double-stranded RNA (dsRNA) is recognized by an RNase III family member and is cleaved into siRNAs of 21 to 23 nucleotides. Next, the siRNAs are incorporated into an RNAi targeting complex called RNA-induced silencing complex (RISC). RISC is a dual function helicase and RNase that recognizes target mRNA. After recognizing a target mRNA, the RISC binds the mRNA and unwinds the siRNA, which allows the antisense strand of the siRNA to bind via complementary base pairing (Watson-Crick base pairing) to the target mRNA. This causes hydrolysis and destruction of the mRNA, which results in decreased protein expression. Furthermore, siRNA is apparently recycled such that one siRNA molecule is capable of inducing cleavage of approximately 1000 mRNA molecules. Therefore, siRNA-mediated RNAi is more effective than other currently available technologies for inhibiting expression of a target gene.
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